Document Detail

Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period?
MedLine Citation:
PMID:  23135262     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cardiac output (CO) is rarely monitored during surgery, and arterial pressure remains the only hemodynamic parameter for assessing the effects of volume expansion (VE). However, whether VE-induced changes in arterial pressure accurately reflect changes in CO has not been demonstrated. The authors studied the ability of VE-induced changes in arterial pressure and in pulse pressure variation to detect changes in CO induced by VE in the perioperative period.
METHODS: The authors studied 402 patients in four centers. Hemodynamic variables were recorded before and after VE. Response to VE was defined as more than 15% increase in CO. The ability of VE-induced changes in arterial pressure to detect changes in CO was assessed using a gray zone approach.
RESULTS: VE increased CO of more than 15% in 205 patients (51%). Areas under the receiver operating characteristic curves for VE-induced changes in systolic, diastolic, means, and pulse pressure ranged between 0.64 and 0.70, and sensitivity and specificity ranged between 52 and 79%. For these four arterial pressure-derived parameters, large gray zones were found, and more than 60% of the patients lay within this inconclusive zone. A VE-induced decrease in pulse pressure variation of 3% or more allowed detecting a fluid-induced increase in CO of more than 15% with a sensitivity of 90% and a specificity of 77% and a gray zone between 2.2 and 4.7% decrease in pulse pressure variation including 14% of the patients.
CONCLUSION: Only changes in pulse pressure variation accurately detect VE-induced changes in CO and have a potential clinical applicability.
Yannick Le Manach; Christoph K Hofer; Jean-Jacques Lehot; Benoît Vallet; Jean-Pierre Goarin; Benoît Tavernier; Maxime Cannesson
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Anesthesiology     Volume:  117     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-22     Completed Date:  2013-05-02     Revised Date:  2013-10-07    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1165-74     Citation Subset:  AIM; IM    
Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
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MeSH Terms
Aged, 80 and over
Arterial Pressure / physiology*
Blood Volume / physiology*
Blood Volume Determination / methods
Cardiac Output / physiology*
Hemodynamics / physiology
Middle Aged
Perioperative Period / methods*
Prospective Studies
Retrospective Studies
Comment In:
Anesthesiology. 2013 Sep;119(3):726   [PMID:  23962931 ]
Anesthesiology. 2013 Sep;119(3):726-7   [PMID:  23962932 ]
Anesthesiology. 2012 Dec;117(6):1151-2   [PMID:  23114266 ]
Anesthesiology. 2013 Sep;119(3):724-5   [PMID:  23962929 ]
Anesthesiology. 2013 Sep;119(3):725-6   [PMID:  23962930 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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